Female Athletes are 3-5 times high risk of ACL injuries than their male counterpart.

Anterior Cruciate Ligament (ACL) injuries are reported 3-5 times more in female athletes than compared to male athletes. This is due to the anatomical structure and biomechanical variable differences seen in female and male population. In recent times, rate of female recreational athletes and fitness enthusiast have reported increase in rate of ACL injuries.

Anatomical factors:

1. Wider hips in female than male contribute towards greater "Q" angle which leads to: Increase hip internal rotation. Increased knee valgus collapse (knee adduction)

2. Higher Body Mass Index (BMI): Higher body mass index in female recreational athletes has been reported as one of the major contributors towards ACL injuries in female athletes.

Biomechanical factors:

1. Female athletes have higher Quadriceps activity in relation to Hamstring. This contributes towards muscle imbalance at the knee joint. In sports science Hamstring: Quadriceps ratio is expected to be 1:1 ratio for prevention of knee injuries, and criteria for return to sports post injury.

2. Core and Spine Control: Non-contact ACL injuries occur in the initial contact phase of running or landing after a jump. A lack of coordinated core and spinal leads of excessive force transition through the knee resulting in ACL injuries.

ACL Preventive Strategies:

A research study done at the Seoul University, South Korea suggests a structured 10 weeks training protocol involving:

• Balanced Hamstring: Quadriceps strength training

• Stability and coordination drills.

• Planned progressive plyometric movement training

reduced risk's of ACL injuries in female athletic population.

References:

1. Griffin LY, Agel J, Albohm MJ, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies [Review]. J Am Acad Orthop Surg. 2000;8:141-150

2. Huston LJ, Greenfield ML, Wojtys EM. Anterior cruciate ligament injuries in the female athlete: potential risk factors [Review]. Clin Orthop. 2000;372:50-63

3. Hewett TE, Paterno MV, Myer GD. Strategies for enhancing proprioception and neuromuscular control of the knee [Review]. Clin Orthop. 2002;402:76-94

4. Jeong J, Choi DH, Song Y, Shin CS. Muscle Strength Training Alters Muscle Activation of the Lower Extremity during Side-Step Cutting in Females. J Mot Behav. 2020;52(6):703-712. doi: 10.1080/00222895.2019.1683505. Epub 2019 Nov 4. PMID: 31679474.